Background and Aims Multimodal analgesia in open spinal fixation surgery allows use of less opiates peroperatively and better patients‘ outcome ¹. Erector spine block significantly reduces peroperative use of opiates during these operations². Non-opioid anesthesia supplemented with ESP block provides good peroperative analgesia and avoids opioid administration during surgery and postoperatively³.

Methods We will describe a series of 10 patients planned for open spine fixation on one or more levels.Before induction in anesthesia, each patient received 1.0 g of Paracetamol.The induction to general anesthesia was with 1 mg/kg Lidocaine,Propofol 2 mg/kg,Ketamine 0.5 mg/kg,Rocuronium 0.6 mg/kg,Sevoflurane 2%,Dexmedetomidine0,5mg/kg/h,Magnesium 30 mg/kg/h continuously.After induction in anesthesia in prone position, we applied bilateral ESP one level above the injury with 2x20ml Bupivacaine 0.25%+Dexamethasone 8mg. Postoperative analgesia was enabled with 2x2g Midazolam, Ketamine 0.05mg/kg/h, Paracetamol 3x1g, Dexamethasone 4mg, Magnesium 1.5g. If the intensity of pain was 7–10 on the VAS scale,amp.Trodon100 mg will be given as a rescue analgesia.Postoperative analgesia was monitored in the next 48 hours,as well as postoperative nausea, vomiting, shaking and opioid dose given postoperatively.

Results Opioid free anesthesia with synergistic action with ESP block provide good perioperative analgesia without use of opioids. The highest pain intensity occurred 8 hours postoperatively.No need of applying rescue analgesia postoperatively. None of the patients had nausea nor vomiting. Transient nystagmus occurred postoperatively in two patients.

Conclusions OFA with ESP are an ideal combination as anesthetic technique that provides good perioperative analgesia.It was avoided application of opioids and their side effects.Patients‘ care and pain control have equal importance as surgical results and have a major impact on the patient‘s perception of their hospital experience.